If you want to expand the number of poor people on Medicaid even though it is worse than private insurance, claim that it will provide universal coverage even though it won’t, and claim that anyone opposed to your idea is just mean, you might need an introduction to the concept of economic efficiency. As Steven Landsburg writes, economic efficiency is a great way to cut through bluster and have reasonable policy discussions. He suggests a health care discussion might go like this
Politician: Here?s my program to make the health care system work better by subsidizing health care for the poor.
Economist: Your program costs a billion dollars and delivers half a billion dollars worth of benefits. That?s inefficient.
Politician: So what?
Economist: Well, the ?so what? is that maybe you could take that billion dollars and deliver a full billion dollars worth of benefits instead if you spent it a little differently. Why not just hand the cash out to poor people?
Politician: Because I don?t want to help all poor people. I only want to help sick poor people ? and this is the only way I can think of to do that.
Economist: Ah. So your goal here is not to make the health care system work better after all. Instead it?s to transfer resources to sick poor people.
Politician: I guess so.
Economist: That?s fine. Now we can have a healthy debate about whether that?s what we want to do.
The Medicaid links above are to Sen. Ben Nelson’s critique of a study on Obamacare’s costs for Nebraska:
“For example, the Milliman study anticipates 100 percent participation in the expanded Medicaid program under health reform. Medicaid is voluntary and voluntary programs never see 100 percent participation.
?Also, the governor?s new study assumes that about 60,000 people who have private insurance now will switch to Medicaid. Will that happen when private insurance generally is better than Medicaid, which also comes with a stigma for some?
